Individual
DR. JONATHAN IAN BENNETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Contact information
Practice address
300 N EUCLID ST, SUITE A, FULLERTON, CA 92832-1623
(714) 888-6860
(714) 888-6867
Mailing address
300 N EUCLID ST, SUITE A, FULLERTON, CA 92832-1623
(714) 888-6860
(714) 888-6867
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
E4301
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
E4301
STATE LICENSE
CA
Enumeration date
09/14/2006
Last updated
06/22/2010
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